Symptoms may include difficult and painful swallowing of liquids and solids.

The lower esophageal sphincter may not function as well for people with achalasia; a reduction of the esophagus’s normal muscle activity (peristalsis) may also occur. Symptoms may include difficult and painful swallowing of both liquids and solids in addition to:

  • Backflow or regurgitation of food
  • Chest pain, which may increase after eating or may be felt in the back, neck, and arms
  • Coughing
  • Heartburn
  • Weight loss

Achalasia most commonly occurs in middle-aged or older adults and may also be genetic. Chagas disease, a condition that results from a parasitic infection, or cancer of the esophagus or upper stomach may also cause similar symptoms.

Diagnosis

Your doctor may notice signs of anemia or malnutrition and may also run the following tests:

  • Esophageal manometry
  • Esophagogastroduodenoscopy
  • Upper GI X-Ray

The diagnostic workup first includes an upper GI barium study and then an endoscopy. The diagnosis is then confirmed by measuring the strength of the esophageal muscles (manometry) to demonstrate the lack of relaxation and abnormal wave of contractions characteristic of achalasia.

Treatment

Achalasia may be treated with medications or directly by injection of relaxing agents such as botulinum toxin into the esophagus. These typically provide only temporary relief. Stretching the lower esophagus though endoscopy to permit the passage of food is another treatment. 

The surgical treatment of achalasia is called a Heller myotomy. This is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to perform the myotomy through several tiny incisions, most of which are less than a half-centimeter in size. Laparoscopic Heller myotomy is a safe and effective treatment for achalasia. However, in the presence of adhesions or variations in anatomy, your surgeon may need to safely complete the procedure through an incision in the chest.

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